Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report -- 42 CFR 413.13, 413.20, 413.24, and 413.157

ICR 199705-0938-002

OMB: 0938-0463

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0463 199705-0938-002
Historical Active 199603-0938-001
HHS/CMS
Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report -- 42 CFR 413.13, 413.20, 413.24, and 413.157
Revision of a currently approved collection   No
Regular
Approved without change 07/22/1997
Retrieve Notice of Action (NOA) 05/23/1997
Approved for use through 7/2000 under the condition that HCFA continues to monitor the burden imposed by these cost reports, in particular any reductions that can be attributed to electronic submission. Prior to the next submission for OMB review, HCFA must submit a correction worksheet for these reductions with a detailed explanation of the assumptions underlying the revised burden estimate.
  Inventory as of this Action Requested Previously Approved
07/31/2000 07/31/2000 05/31/1999
7,000 0 7,000
1,372,000 0 1,372,000
0 0 17,635,096,000

The Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report is the cost report to be used by free-standing SNFs to submit annual information to achieve a settlement of costs for health care services rendered to Medicare beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Skilled Nursing Facility and Skilled Nursing Facility Health Care Complex Cost Report -- 42 CFR 413.13, 413.20, 413.24, and 413.157 HCFA-2540

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7,000 7,000 0 0 0 0
Annual Time Burden (Hours) 1,372,000 1,372,000 0 0 0 0
Annual Cost Burden (Dollars) 0 17,635,096,000 0 -17,635,096,000 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/23/1997


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